Several things…this may ramble a bit. First of all the above is a key chain that the guy that sells the Erec-tech vacuum pump for erectile dysfunction gives me when he comes by. This little trinket was all it took for me the doctor to agree to see him when he comes by. He knows I’ll ask for a couple. I love them and I love saving them to give people. I gave one to a little ole lady in her eighties and she immediately says, ” Can I have another one? I have a friend who would just love it.” Now in addition to being practical, you can never have enough key-chains, the thing is very clever, and I figured this all out myself. The company’s name is Stamens…or Stay-man- get it? Let’s start with the flower. I was at a party one time years ago and the flower arrangement in the room had as it’s center piece this flower. Someone asked me if I knew the name of it and I said yes, ” An Asian penis plant.” It is actually named Anthurium and the yellow thing coming out of the red part is the spadix. Anthurium is Greek for ” tail flower.” You can see why its a nice poster plant for this particular, ” medical device.”
Now the plant was an aside, take a look at the main character on the key-chain. The little vest, that’s why the remark about ” dresses a man out” was used…it seemed to fit (no pun intended) here. The little vest has Sta-man on it and I believe the rectangular thing is their patented venous constriction device. He’s a happy little fellow wouldn’t you say?
Now a brief review of the options for difficulty with erections after any of the forms of the treatment for prostate cancer. In your decision-making you consider that no matter what you do there will be a ED consequence. Just because some treatment is new, i.e. robotic removal or proton radiation or HIFU, doesn’t mean there will not be a negative influence.
All of the treatments available, except the surgical implantation of a penile prosthesis, work by either improving the blood flow in or limits the blood flow out.
All of the oral drugs; Viagra, Levitra, and Cialis, improve the blood flow into the penis. They will usually work if there is at least some baseline function, i.e. the penis gets partially full. I have never seen any of the oral meds work if there is no function. Cialis is different from the others as it has a active period of 36 hours. Despite the ads you’ve seen and heard, it is very uncommon for them to cause priapism (prolonged erections). Look up the Greek God of Priapus—- very ,very interesting history and the origin of the term.
Muse is an intra-urethral pellet that acts like a Viagra formulated to be absorbed transurethrally. It has a small introducer that puts it in the urethra. It can be used if there are reasons you can’t use the oral meds, i.e. patients with heart disease and on meds with nitrate, i.e. nitroglycerin for chest pain. Because the oral meds are vaso dilators and the nitrates are as well, the combination can cause problems with blood pressure and other issues. Some patients use an oral med with muse as their method of solving the ED problem.
Injection therapy or Tri-mix is injected into the side of the penis with a small gauged diabetic needle and directly into the corpora ( the blood filled sinus of the penis that actually does the expanding with erections.) This is potent stuff, usually works very well and does have the real risk of causing priapism. It was knowledge of this medicine, it will work if there has been complete damage of the nerves responsible for erections if one chooses surgical removal of the prostate, that gave me the comfort of going ahead with prostatectomy. I felt that in the worst case scenario I would be very comfortable with this method. Just as men are wimps when it comes to having rectal exams, they cringe at the thought of placing a needle into the penis. It is however not that painful and the effect is almost immediate and dose related.
The vacum device creates a suction that draws blood into the penis and then you flip a constriction device onto the base of the penis while the vacuum creates the erection. The constriction device keeps the blood from leaving the penis and thus keeps it erect until you remove the band. The vacuum device concept is increasingly being used in the immediate post op patient as part of a penile rehabilitation program. The thinking is that the sooner oxygenated blood returns to the penis the better the chance of return of function. Muse and Cialis are also used in the various protocols. Penile rehabilitation
A venous constriction device, (or a glorified celery wide rubber band) can often be used with the oral drugs or Muse convert a partial erection to a full one and is always something to try. It band needs to be snug and not overly tight. You are not preventing blood in, you are preventing blood from going out. Think of pumping up a tire with a hole in it. The hole in the tire is like the venous blood leaving the penis, the band prevents that.
Surgical implantation of a penile prosthesis is a very good option as well but is last resort. To put in the prosthesis cylinders you have to purposely destroy the natural ability of the copora cavernosa to function and so once you ” go here you can’t go back.”
There are problems with all the options. Oral meds can cause flushing of the face, headaches or just don’t work.
Muse can irritate the urethra or won’t work.
The vacuum device works for about 75% and is very dependent on calling the company for ” vacuum tricks.” “Its just not natural.”
Injection therapy involves needles, has a shelf life (unless you purchase the type you mix right when you want it i.e. caverject). Several preparations are mixed by a pharmacist and given to you pre-mixed. I gave a ” recipe” to the pharmacist down the street from our office and that is what I prescribe.
All are expensive and seldom covered adequately by the various insurance companies.
When you see your urologist you should get an overview of all of the above. What you will choose will be determined by cost, what works, side effects, and the preference and how desperate a patient you are and the importance you place on sexual activity. I have patients tell me, ” There is no way in hell I’m gonna put a needle in my penis!” I say, ” Let me know when you want it bad enough. Call me then.” Once again ” Who are you” factors have a role in this touchy aspect of the consequences of this tricky disease.
I hope the above helps… start with the easiest, least intrusive, and least expensive first and then go up the ladder until you find one that works. A guy told me yesterday, “I hope you can do something to help me.” I said, ” Depending on how far you want to take it…I can assure you I’ll be able to help.”
Some patients persist to a solution, some rationalize that that part of the marriage is not that important and drop it early using the surgery as a convenient excuse to ” cease and desist.” Who are you?